FOOD DIARY RECORD
UNIVERSITY OF KANSAS MEDICAL CENTER
Please write down all foods and beverages consumed for three 24-hour time periods. Each day starting at 12:00 am and ending at 11:59 pm. Choose
three consecutive days, including two weekdays and one weekend.
You will be asked to record all vitamin, mineral, and herbal supplements you took at the end of each record.
List the approximate Time the meal was consumed, Place where it was consumed (home, work, name of restaurant, church, etc.), and the type of eating
occasion or Meal (breakfast, lunch, dinner, snack, or other).
List each Food/Beverage Item you consumed, including foods eaten between meals and all drinks, even if it is a non-caloric item like water, coffee,
tea, or sugar free gum.
Specify Details/Ingredients/Preparation of each food or beverage consumed. See the “Three-Day Food Record Checklist” form for details on what to
Record the Amount of each food or beverage consumed. Portion sizes can be recorded in a variety of ways, please use the method that works best for
you. You can use the “Food Amounts Booklet” to help you document portion sizes. Portion sizes can be recorded using the following standard
o Weight in grams or ounces (Not fluid ounces)
o Solid foods – use volume in cups, tablespoons or teaspoons
o Liquids – use volume in fluid ounces
o Fraction of the whole (e.g. 1/8 of 9” pie)
o Dimensions for the following shapes:
Cylinder or disk
Diameter x thickness
Rectangle or cube
Length x height x width
Length x height x width of arc
Brown Sugar Instant
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